My journey began in March 2010 when, to my astonishment, the Patient Protection and Affordable Care Act, also known as, among other names, the "Affordable Care Act" was passed by Congress and signed into law by President Obama. A goal first raised by Teddy Roosevelt about one hundred years ago had seemingly been accomplished – national health care reform had arrived.
Because I represent employers who offer group health plans to their employees, I immediately dived into the law after asking my long-suffering assistant to print the 2700 plus pages. Among the consumer-friendly 2010 changes were requirements to cover children without regard to pre-existing conditions; covering preventive services at 100%; and outlawing annual and lifetime limits on essential health benefits. Among the early changes, I got the most calls from clients about the requirement to cover adult children until age 26 – which, thankfully, has allowed me to keep my young adult son (who has a part-time job and no benefits) on our health insurance plan.
Almost immediately after passage, efforts to repeal the Affordable Care Act were underway. These efforts were accompanied by numerous court challenges to the constitutionality of the law, most targeted at the "individual mandate" to maintain health coverage or pay a penalty. The repeal efforts were beat back in Congress by the Democratic-controlled Senate. The Courts of Appeal decisions were split – some finding the law violated the Constitution and some finding that it did not. This split resulted in the U.S. Supreme Court agreeing to rule on the constitutionality of the law.
In the midst of repeal efforts and court challenges, the Departments of Health and Human Services, Labor and Treasury soldiered forward with interpretive guidance, issuing thousands of pages of proposed and final regulations, notices, "soft guidance" in the form of FAQs, bulletins, etc. I and my colleagues read these thousands of pages, prepared numerous Client Alerts and interpreted the legalese for our clients.
Finally, the big day arrived … June 28, 2012 when the U.S. Supreme Court would announce its decision. I logged onto SCOTUS blog to await the decision. Although most pundits expected the decision to be made on the basis of the commerce clause of the U.S. Constitution, to almost everyone's surprise, Chief Justice Roberts found that the individual mandate of the Affordable Care Act passed muster under Congress' taxing power under the Constitution!
With the Supreme Court's decision and President Obama's re-election this month, implementation of the Affordable Care Act will move forward – not without its challenges and criticisms. Although the Act does expand access to coverage to many more Americans, it remains to be seen whether it will ultimately result in "affordable" coverage. Among the many issues to be confronted in the next year: How will the Exchanges work and will they offer access to affordable coverage? What will employers do? Will they "pay" or "play"? What will the uninsured population do? Will they buy coverage through the Exchange or will they pay the penalty?
For women, there are many things to like about the Affordable Care Act – access to coverage through the Exchanges if you don't have employer health insurance coverage; coverage of preventive services at 100% (get those mammograms, ladies!); and coverage of contraceptives at 100%. Effective January 1, 2014, insurers will no longer be allowed to charge women higher premiums simply because they are women, and they must cover everyone, adults and children, regardless of any pre-existing limitations.
Hopefully, the Affordable Care Act will, over time, meet its goal and expand access to coverage so that no family will ever again have to view the emergency room doctor as their primary care physician.